- Highlight Health (Philadelphia, PA)
- …coding certificates (AHIMA, AAPC, ACDIS, etc.) Database query skills Medicare and/or Medicaid claims experience Experience managing ERISA appeals NSA IDR ... facility claim review experience More than 2 years of hands-on commercial claims experience (Medicare/ Medicaid experience is not sufficient) In depth knowledge… more
- MetroPlusHealth (New York, NY)
- …list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus ... Yorkers to live their healthiest life. Position Overview The Payment Integrity (PI) Analyst will assist in the development of a strategic roadmap to recover,… more
- Molina Healthcare (Long Beach, CA)
- Job Description Job Description Job Summary The Sr Analyst , Risk and Quality Reporting role supports Molina's Risk and Quality Health Plan team. Designs and develops ... on how to use reports related to Risk and Quality/HEDIS for Medicaid , Marketplace and Medicare/MMP. Assists with research, development, and completion of special… more
- Convey Health Solutions (Chicago, IL)
- SUMMARY The Sr. Data Analyst will be responsible for utilizing technical and industry knowledge to accelerate analytic insights and new feature enhancements to ... desired deliverables will be vital to success. Collaborating within a team, the analyst will engage with engineers, QA, Data Scientists, and Product teams using… more
- CGS Administrators, LLC (Nashville, TN)
- …travel between buildings and out of town. Centers for Medicare and Medicaid Services (CMS) Requirements: Certain divisions within BlueCross BlueShield of South ... Carolina require CMS (Centers for Medicare and Medicaid Services) residency that requires employees to have lived...Power BI. Proficiency in Excel. Previous experience in healthcare, claims , prior authorization, supporting DME. What Blue Can Do… more
- Teva Pharmaceuticals (North Wales, PA)
- Medicaid Claims Analyst Date: Jul 8, 2025 Location: North Wales, United States, Pennsylvania, 19454 Company: Teva Pharmaceuticals Job Id: 62333 **Who we ... new people to make a difference with. **The opportunity** **Position Summary:** The Medicaid Claims Analyst is responsible for Medicaid Drug Rebate… more
- Molina Healthcare (Grand Island, NE)
- …interaction experience + Experience working with complex, often highly technical teams + Medicaid primary and Medicare preferable payer claims experience + QNXT ... Nebraska Health plan SLT by providing subject matter expertise on complex claims related issues and service recovery efforts.** Analyzes complex business problems… more
- TEKsystems (Brookfield, WI)
- …ICD9, medical claims processing, Medicaid Top Skills Details Claims processing, Claims Analyst ,Medicare,CPT coding,ICD9,medical claims processing ... Description As a Claims Analyst II you will be...Description As a Claims Analyst II you will be tasked with the...Coding experience preferred. - Past experience using QNXT (TM) Claims Workflow a plus - Medicaid /Medicare Experience… more
- Commonwealth Care Alliance (Boston, MA)
- …coding (CPT, HCPCS, Modifiers) along with the application of Medicare/Massachusetts Medicaid claims ' processing policies, coding principals and payment ... TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible...Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for claims ,… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, ... resolution of complex reimbursement issues - including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on … more
- CVS Health (Topeka, KS)
- …And we do it all with heart, each and every day. **Position Summary** The Medicaid Intake Business Operations team seeks an analyst with expertise in electronic ... This team ensures the quality and integrity of Intake processes for all Medicaid incoming claim transactions. In this position, you will provide initial support for… more
- Zelis (Plano, TX)
- …the personal interests that shape who you are. Position Overview The Sr. Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory ... communicating rules, regulations, and procedures pertaining to public and private Medicaid payment systems. This position requires an in-depth knowledge of… more
- Insight Global (Mason, OH)
- Job Description A large vision insurance company in the Mason, OH area is seeking a Claims Analyst . for a contract role. This person will be required to work in ... . Skills and Requirements 2+ years of experience in claims analyst , data analyst or...SQL - run queries, read reports generated Visions experience Medicaid knowledge Facets SAP null We are a company… more
- Commonwealth Care Alliance (Boston, MA)
- …not be considered at this time._** Position Summary: Working under the direction of the SVP Claims , the Senior Data Analyst - Payment Integrity & Claims will ... 011250 CCA- Claims **_This position is available to remote employees...care reimbursement, public health care programs and reimbursement methodologies ( Medicaid and Medicare) * Ability to work cross functionally… more
- Molina Healthcare (Buffalo, NY)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... on researching, presenting and documenting is required, + Experience with Medicare, Medicaid and Marketplace is required. + Medical coding experience is highly… more
- Montrose Memorial Hospital (Montrose, CO)
- …knowledge of hospital billing, collections and payment application for Medicare, Medicaid and Commercial insurances + Ability to effectively communicate, verbally, ... and non-verbally, in a clear, concise manner, both orally and in writing. What We Offer: + Mentoring + Continuing Education + 401 K Retirement Plan with employer match + Multiple health options to selection from + Ability to earn an additional $5.00 per hour… more
- Molina Healthcare (Provo, UT)
- …at a health plan or vendor-is strongly preferred. **Knowledge/Skills/Abilities** + Review Medicaid COB claims for correct secondary pricing logic and compliance ... **Job Description** **Job Summary** We are seeking a highly experienced Lead Analyst , Configuration Oversight to support our Payment Integrity and Claims … more
- MyFlorida (Tallahassee, FL)
- …Agency's Medicaid fiscal agent; responsible for the processing of Florida Medicaid claims and multiple supporting systems; ensuring Medicaid providers ... 68064861 - MEDICAL/HEALTH CARE PROGRAM ANALYST Date: Jul 23, 2025 The State Personnel...entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000… more
- Prime Therapeutics (Eagan, MN)
- …to determine work assignments within project + Educate and advance business systems analyst practice within the Claims IT team and across the organization ... and drives every decision we make. **Job Posting Title** Sr. Business Systems Analyst **Job Description** The Sr. Business Systems Analyst (BSA) is responsible… more
- System One (Dayton, OH)
- Job Title: Encounters System Analyst Location: Remote Type: Contract Contractor Work Model: Remote Title: Encounters System Analyst ALTA is supporting an 8-month ... Data & Advanced Analytics, and Agile Transformation Services. The Encounters System Analyst IV is responsible for overall State and Federal(CMS) level Encounters… more
